First Things First (assess & treat for the following)

• These side effects can occur in the marrow or systemically, and hematologic effects of drugs can be mediated by one or many factors.

• Dysfunction can range in severity from mild to severe, and the clinical picture is variable.
• Hemolysis is usually not severe, but life-threatening cases do occur, esp. in pts with comorbid conditions.
• Some drug-induced disorders may occur weeks to years after use.
• Suspect cephalosporin- or quinidine-induced hemolytic anemia if acute, severe hemolysis occurs with renal failure.
• Diagnostic tests are not always specific; usually the diagnosis made with history, physical & removal of suspected drug.
• Suspect drug-induced hemolytic anemia if:
  • Anemia, fevers, rash, renal failure develop when drug started
  • Hemolytic indices are seen:
    • Anemia, cytopenias
    • Reticulocytosis
    • Increased LDH
    • Decreased haptoglobin
  • Increased indirect bilirubin
  • Hemoglobinuria

• Discontinue any new drug that may be responsible for a recent change in pt’s condition.